TRICARE pays for covered medical services for TRICARE Prime beneficiaries that are authorized in advance by the PCM. Think of your PCM as the provider that focuses on your overall health that has the ability to guide you to other health care professionals - specialists, hospitals, rehabilitation facilities, etc. For example, if you need to see a heart specialist, your PCM will refer you to a cardiologist.

The Referral Cycle

TRICARE has contracted with a vast network of providers and hospitals that are dedicated to serving the needs of its beneficiaries. Your PCM can refer you to any physician in the TRICARE network if the need for a specialist arises. All care (except emergency care) should begin with your PCM. If you follow this rule, you will avoid authorization and billing problems.

Step 1: See your PCM. Ensure the clinic personnel have your current address and telephone number and that your address is correct in DEERS.

Step 2: Acquire a referral from your PCM. Clinic personnel will coordinate with TRICARE to arrange for a referral to a civilian network specialist.

Step 3: TRICARE will make sure that the requested service is a covered TRICARE benefit to avoid unnecessary out-of-pocket costs to you.

Step 4: For all services except Radiology, TRICARE will send you a letter that includes the specialist's name, address and telephone number. DO NOT schedule an appointment until you receive this authorization letter. If you have not received your letter from TRICARE within 5 to 7 business days, or if you would like a different network specialist, call 877-TRICARE.

Step 5: When you have arranged an appointment, you must contact the Referral Management Center at ???-???-???? to leave a message on a confidential voice mail with the specialist's name and date of your appointment. This is critical for ensuring TRICARE is able to get your consultation results back to your Hanscom PCM for follow-up.

IMPORTANT: If your specialist believes you need additional medical services, the specialist needs to contact TRICARE to make these arrangements. You do not need to contact your PCM for authorization; this is arranged between the specialist and TRICARE.

Step 6: If you cannot keep or wish to change the date of your specialty appointment, please call the specialist directly to reschedule your appointment and then notify the Referral Management Center at ???-???-???? of your new appointment date.

Step 7: When you go to your appointment take a copy of the authorization letter, pertinent medical records, x-rays and laboratory results with you.